Medical Director – Inpatient Review

🕒 July 1

🇺🇸 United States – Remote

💵 $223.8k - $313.1k / year

⏰ Full Time

🔴 Lead

👨‍⚕️ Medical Director

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Humana

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1961

⚕️ Healthcare Insurance

Healthcare Insurance

Humana is a healthcare company dedicated to making a positive impact on the health of individuals, communities, and the healthcare system as a whole. With a focus on putting health first, Humana serves a diverse range of populations, including seniors and the military, providing Medicare Advantage HMO, PPO, and PFFS plans. Humana is committed to fostering a culture of belonging and mutual respect, offering competitive and flexible benefits to ensure the financial security of its employees and their families. The company prides itself on creating an inclusive workplace where everyone has the opportunity to succeed.

📋 Description

• Perform expert clinical review of inpatient medical records, assessing medical necessity based on national guidelines, CMS regulations, Humana policies, and recognized clinical standards • Analyze complex hospital-based cases and deliver clear, well-reasoned utilization management determinations • Communicate with external providers via phone to obtain clinical information and discuss review outcomes • Collaborate within a structured, team-oriented environment that emphasizes integrity, professionalism, and collegiality • Conduct inpatient medical necessity reviews promptly and in accordance with regulatory requirements • Uphold excellence in productivity, accuracy, quality, and timely completion of assigned tasks • Communicate review outcomes clearly and professionally in both verbal and written formats • Demonstrate flexibility and adaptability to changing workflows, tools, and utilization management procedures

🎯 Requirements

• MD or DO • 5 or more years post-residency clinical experience • Active, unrestricted medical license in at least one state and willingness to obtain additional licenses as needed • Current and ongoing Board Certification in an AOABPS- or ABMS-recognized medical specialty • Meets all credentialing requirements, with no state or federal sanctions • Strong analytical, communication, and documentation skills • Ability to work effectively within a structured environment and as part of a multidisciplinary team

🏖️ Benefits

• medical, dental and vision benefits • 401(k) retirement savings plan • time off (including paid time off, company and personal holidays, paid parental and caregiver leave) • short-term and long-term disability • life insurance